Both congenital penile curvature (CPC) and Peyronie’s disease may cause ventral curvature, which, depending on severity, can lead to functional limitations during sexual activity and may require surgical correction. Previous studies have suggested that men with ventral curvatures report more dissatisfaction with penile appearance, increased difficulty with intercourse, and psychological problems.¹ Historically, surgical techniques for correcting this type of deformity were associated with longer operative times and greater patient dissatisfaction, mainly due to neurovascular bundle (NVB) dissection and its complications.²

In fact, ventral curvature is a rarer presentation of penile deformity, and it is more commonly seen in CPC. Grafting techniques for ventral curvatures require urethral mobilization, which can potentially compromise blood supply to the glans or result in urethral complications, posing a challenge for treatment.^3-4 Additionally, in CPC patients, the penile length is typically recognized as above average, and the deformity often exhibits an arch-form rather than a hinge-form aspect. Therefore, a multiple plication strategy along the dorsal face of the shaft is an appealing approach to better address the deformity and preserve erectile function, and is highly likely to result in a functional shaft.^3-4

Previous studies described a midline dorsal plication technique in pediatric patients, allowing for an effective correction without requiring NVB manipulation.^5-8 Neuroanatomical studies have demonstrated the distribution of nerve fibers and identified the 12 o’clock position as the only nerve-free position.⁵ Finally, in 2021, Bagnara et al published description, results, and long-term follow-up of the Giammusso corporoplasty in adults.⁹

This article is a summary of the video presented at AUA2023 and consists of a step-by-step description of this previously published technique for ventral penile curvature correction. The images presented here are a compilation of images from 3 surgeries utilizing an adaptation of the Giammusso corporoplasty technique: a 26-year-old male with a 62-degree ventral CPC, a 77-year-old male with a 68-degree Peyronie’s disease ventral curvature, and a 29-year-old male with a 28-degree ventral CPC but persistent complaint due to penile instability.

The Procedure

Patients underwent either general or spinal anesthesia. A penile block with bupivacaine was also performed for further postoperative pain control for those undergoing general anesthesia. In all cases, a subcoronal incision was performed, and penile skin and Dartos’ fascia were degloved. The point of maximum curvature, the beginning, and the end of the curvature were identified and marked after saline-induced artificial erection using an 18-gauge butterfly needle inserted through the glans. We did not apply a proximal tourniquet during the procedure as manual compression and appropriate-sized butterfly is already efficient to generate rigidity. Buck’s fascia was incised along the midline (Figure 1), and the deep dorsal vein and its branches were then carefully dissected (Figure 2). The deep dorsal vein was tied up, resected, and removed (Figure 3). Differently from the Giammusso technique, we did not perform a corporoplasty but a simple plication as described by Akdemir et al.⁸ This latter technique, however, spares the deep dorsal vein. For the plication, after planning and marking their sites with Allis clamps and artificial erection confirming functional alignment, we utilized 3 inverted nonabsorbable 2-0 coated polyester sutures for each plication site (Figure 4). Circumcision was performed for penile shaft closure.

The 3 patients shown in our video obtained functional penile alignment (Figure 5), and no change in glans sensation was reported. No severe adverse event was observed, with 1 patient developing a small penile hematoma managed conservatively. It is noteworthy that the AUA guidelines describe up to 35.5% of cases reporting palpable or painful sutures following plication surgery,¹⁰ which contrasts with our experience where such complaints are rarely encountered. We believe that the inverted technique and the choice of Ethibond (coated polyester), a suture with softer consistency than other commonly chosen nonabsorbable sutures for plication such as Prolene (polypropylene), reduces the chance of such complaints.

Conclusions

We believe we were successful in our goal to propagate this interesting approach for ventral penile deformity. Our experience further reinforces previous literature that deep dorsal vein bed plication is a viable and effective technique for treating ventral penile curvature, whether congenital or acquired. One of the significant advantages of this technique is the avoidance of NVB dissection, which not only reduces surgical time but also minimizes associated risks.

Source of Funding: None

Disclosure Statement: The Authors have no conflicts of interest to disclose.